Medicaid Long Term Care Unit
The Medicaid Long Term Care Unit determines financial eligibility for nursing home placement and Medicaid Waiver programs.
Have a general question for the Medicaid Long Term Care Unit? Use our Contact Form or call (609) 645-7700, ext. 4318.
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To Qualify for Medicaid Financially
The gross monthly income limit for Long Term Care Medicaid (also referred to as MLTSS or Managed Long Term Services and Supports) is $2,829.00. Applicants with income higher than the $2,829.00 cap must set up a Qualified Income Trust (QIT). Eligibility for Medicaid cannot be granted prior to the establishment and funding of this trust. (For more information, go to the State of NJ Qualified Income Trusts page.)
Resources must be below $2,000 prior to the month of eligibility (for applicants without a spouse in the community). Resources include, but are not limited to: Bank accounts, Stocks, Bonds, CD’s, Real Estate, Life Insurance (cash value). Do not transfer or gift assets in order to meet this resource limit. Doing so will result in a penalty period in which the applicant will be ineligible for Medicaid. Monies must be “spent down” on expenses incurred by the applicant directly related to his/her care and needs. Keep receipts for all expenses.
To Qualify for Medicaid Medically
Medical eligibility will be determined by the State of New Jersey. The process of obtaining this approval is initiated with a PA-4 form completed by the applicant’s physician. For applicant’s who are hospitalized, eligibility may also be determined while in the hospital.
Please note: Applying for Medicaid does not guarantee coverage. In the event that an applicant enters a Medicaid approved facility prior to approval, he/she will be responsible for any expenses incurred before the Medicaid eligibility effective date. Furthermore, the Managed Long Term Services and Support (MLTSS) (Assisted Living and homecare) requires additional State approval. The approval for a Medicaid slot in Managed Long Term Services and Support (MLTSS) is often well after the applicant is found financially eligible by the County office. Please be advised that you are responsible for all payments due to the Assisted Living Facility prior to the effective date of the slot approval.
Post-Eligibility Treatment of Income
When a Medicaid recipient is admitted to a Long Term Care Facility, any income received must be given to that facility. This includes income received during the month of admission. (For example: If an individual is admitted to the nursing home on the 27th of April, income received from the 1st of April forward must be given to the nursing home.) If any of the money was used for bills, verification of these bills should be presented to the Medicaid Unit. Verified bills will be deducted from the amount of income (for the month of admission only), and the remainder of the income will be available to the nursing home.
Subsequent to the month of admission, the allowable deductions from the patient’s income are $50 for his/her Personal Needs Account (PNA), monthly health insurance premiums, and community spousal allowance (if eligible). In order to take a deduction for the health insurance, the Medicaid Unit will need a copy of the most recent health insurance bill.
The Dos
- Keep applicant’s bank statements.
- Keep financial information organized.
- Consolidate banking into one account.
- Ask for help.
- Provide as much information as possible.
- Spend $ on the applicant’s bills and care.
The Don’ts
- Don’t give $ or property away in order to meet the resource limit.
- Don’t shred important documents.
- Don’t withhold any information.
- Don’t pay family’s or friends’ bills with applicant’s money.
- Don’t be afraid to ask questions.
Documents You May Need to Provide
Depending on your particular circumstances you may be asked to provide some or all of the following forms. For example if you do not have Life Insurance you will not be expected to provide information regarding a policy.
- Health Insurance (copy both sides of card and premium bill with amount due)
- Income Verification (Letterhead/Stub showing net and gross of: Private Pension Checks, Annuity Funds, Social Security, VA Pensions)
- Doctor’s Evaluation (PA-4, and/or PA-5 and PA-6)
- Spouse’s:
- Income
- Social Security Card
- Date of Birth
- Marriage Certificate or Divorce Decree or Death Certificate
- Verification of Power of Attorney or Guardianship
- Life Insurance: (Letter showing name of company providing current face value and cash value)
- Burial Plot and/or Prepaid Irrevocable Funeral Arrangements
- Statements from all bank accounts (checking and saving, CDs, IRAs, 401ks, stocks, bonds, money market, etc.) open at any time during the 5 years prior to the first date of applying for Medicaid benefits may be requested.
- Be prepared to provide, at a minimum, the last year of statements and one statement per quarter for the prior years in the lookback period.
- All statements must include check images, as well as documentation regarding the source of any non-electronic deposits.
- Ownership of property verified by DEED
- Rental Lease or Rent Receipt
- Residential Expenses (Mortgage Bill, Tax Bill, Utility Bill, Home Owner’s Insurance, Monthly Maintenance and Condo Fee)
Contact
For more information, contact (609) 645-7700, ext. 4318 or submit our on-line contact request form.